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Comprehensive Guide to Mesh and Fixation in Laparoscopic Inguinal Hernia Repair

Dive into the world of mesh classification, properties, immune response, fixation methods, and implications on recurrence, pain, wound complications, and overall quality and value in hernia repair surgery. Stay informed to optimize patient outcomes.

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Comprehensive Guide to Mesh and Fixation in Laparoscopic Inguinal Hernia Repair

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  1. Mesh and fixation in Laparoscopic inguinal hernia repair Mr Duncan Light Consultant upper GI surgeon Northumbria NHS Trust www.nugit.nhs.uk

  2. Mesh classification • Synthetic • Polypropylene • PVDF • Polyester • Biosynthetic • PGA • P4HB • Biological • Porcine • Bovine • Fetal • Cadaver • Structure/weave • Pore size • > 1mm • Weight • 80gm2 • Mechanical properties • Tensile strength • Stiffness • Elasticity • Complicance

  3. Mesh immune response • Foreign body response • Fibroblasts and immune response • Chronic process • Granuloma formation • Scar plate • Implicated in mesh shrinkage • Potential reduction with large pore size (>1mm)

  4. RECURRENCE CHRONIC PAIN WOUND COMPLICATIONS QUALITY -------------------- VALUE = COST READMISSIONS HOSPITAL VISITS LOS RESOURCES

  5. Fixation • Tacks • Absorbable • Non-absorbable • Staples? • Glue • Fibrin • Cyanoacylate • Self-fixating mesh

  6. Fixation

  7. RECURRENCE CHRONIC PAIN WOUND COMPLICATIONS QUALITY -------------------- VALUE = COST READMISSIONS HOSPITAL VISITS LOS RESOURCES

  8. References • International guidelines for groin hernia management. Herniasurge group. Hernia 2018. 22 (1): 1-65 • Past, Present and Future of Surgical Meshes: A Review. Baylon, Karen & Rodríguez-Camarillo, Perla & Elías-Zúñiga, Alex & Díaz-Elizondo, José & Gilkerson, Robert & Lozano, Karen. (2017). Membranes. 7. 47

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